subtrochanteric stress fracture
Jump to navigation
Jump to search
Etiology
- bisphosphonate therapy for > 5 years
Clinical manifestations
- sudden right hip snapping sound
- inability to bear weight[12]
- pain in the groin & the proximal thigh
- range of motion of hip is normal
- deep tendon reflexes are normal
- hip extension in the prone position is painless
- pain localized to the proximal thigh on palpation
- no rash
Radiology
- increased femoral cortical width on the previous plain radiograph
Differential diagnosis
- osteoporotic fracture (insufficiency fracture, minimal trauma fracture)
- osteoarthritis of the hip
- range of motion of hip is not normal
- trochanteric bursitis
- pain over trochanteric bursa
- L3 radiculopathy (hyporeflexia)
Management
- stop bisphosphonate
More general terms
References
- ↑ Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
- ↑ Giusti A, Hamdy NA, Dekkers OM et al Atypical fractures and bisphosphonate therapy: a cohort study of patients with femoral fracture with radiographic adjudication of fracture site and features. Bone. 2011 May 1;48(5):966-71. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21195812
- ↑ Nieves JW, Cosman F. Atypical subtrochanteric and femoral shaft fractures and possible association with bisphosphonates. Curr Osteoporos Rep. 2010 Mar;8(1):34-9. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20425089
- ↑ Schilcher J et al. Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med 2011 May 5; 364:1728. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21542743
- ↑ FDA Medwatch Oral Bisphosphonates: Ongoing Safety Review of Atypical Subtrochanteric Femur Fractures http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm204127.htm
- ↑ Shane E, Burr D, Abrahamsen B, Adler RA et al Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014 Jan;29(1):1-23. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23712442 Free Article
- ↑ Tyler W, Bukata S, O'Keefe R. Atypical femur fractures. Clin Geriatr Med. 2014 May;30(2):349-59. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24721373
- ↑ Park-Wyllie LY, Mamdani MM, Juurlink DN Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA. 2011 Feb 23;305(8):783-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21343577
- ↑ Kayali C, Altay T, Ozan F et al. Atypical femoral shaft fractures secondary to long-term bisphosphonate therapy. J Orthop. 2017;14(2):226-230 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28203048 PMCID: PMC5293726 Free PMC article https://doi.org/10.1016/j.jor.2017.01.002
- ↑ Starr J, Tay YKD, Shane E. Current understanding of epidemiology, pathophysiology, and management of atypical femur fractures. Curr Osteoporos Rep. 2018;16(4):519-529 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29951870 PMCID: PMC6061199 Free PMC article https://link.springer.com/article/10.1007/s11914-018-0464-6
- ↑ Dell R, Greene D. A Proposal for an Atypical Femur Fracture Treatment and Prevention Clinical Practice Guideline. Osteoporos Int. 2018;29(6)1277-1283 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29675745 https://link.springer.com/article/10.1007/s00198-018-4506-9
- ↑ 12.0 12.1 Black DM et al. Atypical femur fracture risk versus fragility fracture prevention with bisphosphonates. N Engl J Med 2020 Aug 20; 383:743. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32813950 https://www.nejm.org/doi/10.1056/NEJMoa1916525